Vaccinations in Paediatric Rheumatology: an Update on Current Developments

Abstract

In 2011, the European League Against Rheumatism (EULAR) published recommendations regarding the vaccination of children with rheumatic diseases. These recommendations were based on a systematic literature review published in that same year. Since then, the evidence body on this topic has grown substantially. This review provides an update of the systematic literature study of 2011, summarizing all the available evidence on the safety and immunogenicity of vaccination in paediatric patients with rheumatic diseases. The current search yielded 21 articles, in addition to the 27 articles described in the 2011 review. In general, vaccines are immunogenic and safe in this patient population. The effect of immunosuppressive drugs on the immunogenicity of vaccines was not detrimental for glucocorticosteroids and methotrexate. Biologicals could accelerate a waning of antibody levels over time, although most patients were initially protected adequately. Overall, persistence of immunological memory may be reduced in children with rheumatic diseases, which shows the need for (booster) vaccination. This update of the 2011 systematic literature review strengthens the evidence base for the EULAR recommendations, and it must be concluded that vaccinations in patients with rheumatic diseases should be advocated.

Current information about vaccination practice in pediatric rheumatic diseases and recommendations for future applications

“…[7][8][9] In patients with rheumatic diseases, immunogenicity of a vaccine can differ from the healthy population, because of the disease itself or the immunosuppressive treatment received. 10 Moreover, possible effects of vaccination on the underlying disease should be considered. In general, live attenuated vaccines should not be administered when high-dose immunosuppressive drugs are used for immunosuppressed patients (solid organ transplantation, hematologic malignancy, immunodeficient patients).…”

“…15 The incidence of influenza infection is not yet known for the pediatric patients with RD. 10 There are studies indicating the risk of influenza in elderly patients with RD, and a beneficial effect of vaccination on admission for pneumonia/flu or death. 16 Six studies involving 353 patients are in favor of the safety and immunogenicity of vaccination against seasonal influenza in pediatric patients with RD.…”

“…29,[32][33][34][35] Humoral response after HBV vaccination should be checked, because antibody titers may fall below their protective levels over time, and a booster dose is needed. 10,32,33 The literature is controversial on the safety of HBV vaccine in autoimmune diseases. Several autoimmune manifestations have been described after HBV vaccine, such as vasculitis, SLE, RA, seronegative arthropathies.…”

“…10 In a study including 63 JIA patients and 48 healthy controls, all participants were found seropositive up to 12 months following bHPV vaccination. Antibody levels were found to be lower in patients than controls, but no statistical significant difference was determined in results over time.…”

“…Future controlled studies in larger group of jSLE patients are needed to evaluated the immunogenicity of the HPV vaccine in this group. 10 …”